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Non-surgical Volume Enhancement with Fillers in the Orbit and Periorbital Tissues: Cosmetic and Functional Considerations

  • Chapter
Oculoplastics and Orbit

Part of the book series: Essentials in Ophthalmology ((ESSENTIALS))

Abstract

  • Orbital or periorbital volume loss may be due to factors other than aging. Any sinister, progressive, or reversible etiology should be identified and addressed prior to embarking upon volume replacement.

  • Injectable soft-tissue fillers offer titratable volume augmentation, precise soft-tissue placement, the ability to be performed in the office, biocompati-bility, low down-time, minimal morbidity, high safety and, in most cases, potential reversibility.

  • The two main types of injectable soft-tissue fillers are collagen and stabilized hyaluronic acid. The latter can be instantly dissolved using hyaluroni-dase. Nonanimal stabilized hyaluronic acid fillers are the most commonly used in orbital and periorbital volume augmentation.

  • Fillers with larger particle size have increased viscos-ity reduced ease of injection and increased duration. On average, a medium viscosity hyaluronic acid gel will last a year when injected in a pre-periosteal plane in the periorbital region or in the orbit.

  • Soft-tissue fillers have been successfully used for volume augmentation in the orbit (both sighted and anophthalmic), the tear trough, the upper eyelid/sub-brow region and in the brow and temple region.

  • 2 ml of hyaluronic acid filler, administered to the orbit via an inferotemporal peribulbar injection and placed posterior to the equator of the globe or implant, usually reduces enophthalmos by up to 2 mm and restores the signs of periorbital volume deficiency.

  • A serial-puncture technique, with deep pre-periosteal placement of small aliquots of filler, followed by molding and massage of the gel, is recommended for filling in periorbital region.

  • Typical side effects of periorbital filler injection include bruising and mild swelling, although these usually resolve within a few days and can be concealed with make-up or glasses.

  • Lumpiness can be a problem in a minority of patients but usually settles. Persistent lumpiness can be corrected with further molding, additional filler or, in the case of hyaluronic acid fillers, dissolution with hyaluronidase.

  • Patient satisfaction following periorbital soft- tissue filler for rejuvenation is between 80–95%.

  • The role of injectable soft-tissue fillers in treating periorbital pathology is continuing to expand, with reports of their successful use in treating paralytic lagophthalmos, lower eyelid retraction and cicatricial ectropion.

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References

  1. Airan LE, Born TM (2005) Nonsurgical lower eyelid lift. Plast Reconstr Surg 116:1785–1792

    Article  PubMed  CAS  Google Scholar 

  2. Apte RS, Solomon SD, Gehlbach P (2003) Acute choroidal infarction following subcutaneous injection of micronized dermal matrix in the forehead region. Retina 23:552–554

    Article  PubMed  Google Scholar 

  3. Balazs EA, Denlinger JL, Leshchiner E, et al (1988) Hyaluronan derivatives for softtissue repair and augmentation. Biotech USA Nov:14–16, 442–445

    Google Scholar 

  4. Berman M (2000) Rejuvenation of the upper eyelid complex with autologous fat transplantation. Dermatol Surg 26:1113–1116

    Article  PubMed  CAS  Google Scholar 

  5. Bosniak S, Cantisano-Zilkha M (2001) Restylane and Perlane: A six year clinical experience. Operative Techniques in Oculoplast, Orbital and Reconstr Surg 4:89–93

    Article  Google Scholar 

  6. Broder K W, Cohen SR (2006) An overview of permanent and semipermanent fillers. Plast Reconstr Surg 118 (Suppl):7S–14S

    Article  PubMed  CAS  Google Scholar 

  7. Buonaccorsi S, Leonardi A, Covelli E, et al (2005) Parry-Romberg stndrome. J Craniofac Surg 16:1132–1135

    Article  PubMed  Google Scholar 

  8. Buono LM (2004) The silent sinus syndrome: maxillary sinus atelectasis with enophthalmos and hypoglobus. Curr Opin Ophthalmol 15:486–489

    Article  PubMed  Google Scholar 

  9. Burroughs JR, Hernandez Cospin JR, Soparkar CN, Patrinley JR (2003) Misdiagnosis of silent sinus syndrome. Ophthal Plast Reconstr Surg 449–454

    Google Scholar 

  10. Cahil K V, Burns JA (1989) Volume augmentation of the anophthalmic orbit with cross-linked collagen (Zyplast®). Arch Ophthalmol 107:1684–1686

    Article  Google Scholar 

  11. Carey DL, Baker D, Rogers GD, et al (2007) A randomized multicenter open-label study of poly-L-lactic acid for HIV-1 facial lipoatrophy. J Acquir Immune Defic Syndr 46:581–589

    Article  PubMed  CAS  Google Scholar 

  12. Carruthers A, Carruthers J (2007) Non-animal-based hyaluronic acid fillers: scientific and technical considerations. Plast Reconstr Surg 120(6 Suppl):33S–40S

    PubMed  CAS  Google Scholar 

  13. Ciuci PM, Obagi S (2008) Rejuvenation of the periorbital complex with autologous fat transfer: current therapy. J Oral Maxillofac Surg 66:1686–1693

    Article  PubMed  Google Scholar 

  14. Cline RA, Rootman J (1984) Enophthalmos:a clinical review. Ophthalmology 91:229–237

    PubMed  CAS  Google Scholar 

  15. Coleman SR (1997) Facial recontouring with lipostructure Clin Plast Surg. 24:347–367

    PubMed  CAS  Google Scholar 

  16. Coleman SR (2004) Structural fat grafting. Quality Medical Publishing, St Louis, MO

    Google Scholar 

  17. Coleman SR, Grover R (2006) The anatomy of the aging face: volume loss and changes on 3-dimensional topography. Aesthetic Surg J 26(1 Suppl):S4–S9

    Article  CAS  Google Scholar 

  18. Da Silva AL, Bredemeier M, Gebrim ES, Moura Eda M (2008) Intraorbital polyacramide gel injection for the treatment of anophthalmic enophthalmos. Ophthal Plast Reconstr Surg 24:367–371

    Article  PubMed  Google Scholar 

  19. Danesh-Meyer H V, Savino PJ, Sergott RC (2001) Case reports and small case series: ocular and cerebral ischemia following facial injection of autologous fat. Arch Ophthalmol 119:777–778

    PubMed  CAS  Google Scholar 

  20. DeLorenzi C, Weinberg M, Solish N, Swif A (2006) Multicenter study of the efficacy and safety of subcutaneous non-animal-stabilised hyaluronic acid in aesthetic facial contouring: interim report. Dermatol Surg 32:205–211

    Article  PubMed  CAS  Google Scholar 

  21. Donath AS, Glasgold RA, Glasgold MJ (2007) Volume loss versus gravity: new concepts in facial aging. Curr Opin Otolaryngol Head Neck Surg 15:238–243

    Article  PubMed  Google Scholar 

  22. Donofrio LM (2000) Fat distribution: a morphologic study of the aging face. Dermatol Surg 26:1107–1112

    Article  PubMed  CAS  Google Scholar 

  23. Fagien S, Klein A (2007) A brief overview and history of temporary fillers: evolution, advantages and limitations. Plast Reconst Surg 120 (Suppl):8S

    PubMed  CAS  Google Scholar 

  24. Fezza JP Nonsurgical treatment of cicatricial ectropion with hyaluronic acid filler (2008) Plast Reconstr Surg 121:1009–1014

    Article  PubMed  CAS  Google Scholar 

  25. Flowers RS (1993) Tear trough implants for correction of tear trough deformity. Clin Plast Surg 20:403–415

    PubMed  CAS  Google Scholar 

  26. Frileck SP (2002) The lumbrical fat graft : a replacement for lost upper eyelid fat. Plast Reconstr Surg 109:1696–1705

    Article  PubMed  Google Scholar 

  27. Goldberg RA (2000) Lower blepharoplasty is not about removing skin and fat. Arch Facial Plast Surg 2:22

    Article  PubMed  CAS  Google Scholar 

  28. Goldberg RA (2000) Transconjunctival orbital fat repositioning: transposition of orbital fat pedicles into a subpe-riosteal pocket. Plast Reconstr Surg 105:743–748

    Article  PubMed  CAS  Google Scholar 

  29. Goldberg RA (2006) Periorbital Restylane®:my practice to yours. Aesth Surg J 86:69–71

    Article  Google Scholar 

  30. Goldberg RA, Fiashetti D (2006) Filling the orbital hollows with hyaluronic acid gel: initial experience with 244 injections. Ophthal Plast Reconstr Surg 22:335–341

    Article  PubMed  Google Scholar 

  31. Goldberg RA, McCann JD, Fiaschetti D, Ben Simon GJ (2005) What causes eyelid bags? Analysis of 114 consecutive patients. Plast Reconstr Surg 115:1395–402

    Article  PubMed  CAS  Google Scholar 

  32. Goldberg RA, Lee S, Jayasundera T, et al (2007) Treatment of lower eyelid retraction by expansion of the lower eyelid with hyaluronic acid gel. Ophthal Plast Reconstr Surg 23:343–348

    Article  PubMed  Google Scholar 

  33. Gravier MH, Bass LS, Busso M, et al (2007) Calcium hydroxlapatite (Radiesse) for correction of the mid- and lower face: concensus recommendations. Plast Reconstr Surg 120(Suppl):55S–66S

    Article  Google Scholar 

  34. Hamra S (1995) Arcus marginalis release and orbital fat preservation in midface rejuvenation. Plast Reconst Surg 96:354–362

    Article  PubMed  CAS  Google Scholar 

  35. Hester TR, Codner MA, McCord CD, et al (1988) Transorbital lower lid and midface rejuvenation. Oper Tech Plast Reconstr Surg 5:163

    Article  Google Scholar 

  36. James J, Carruthers A, Carruthers J (2002) HIV-associated facial lipoatrophy. Dermatol Surg 28:979–986

    Article  PubMed  Google Scholar 

  37. Kane MAC (2005) Treatment of tear trough deformity and lower lid bowing with injectable hyaluronic acid. Aesth Plast Surg 29:363–367

    Article  Google Scholar 

  38. Knapp TR, Kaplan EN, Daniels JR (1977) Injectable collagen for soft-tissue augmentation. Plast Reconst Surg 60:389

    Google Scholar 

  39. Kotlus BS, Dryden RM (2007) Correction of anophthalmic enophthalmos with injectable calcium hydroxlapatitie (Radiesse). Ophthal Plast Reconstr Surg 23:313–314

    Article  PubMed  Google Scholar 

  40. Kranendonk S, Obagi S (2007) Autologous fat transfer for periorbital rejuvenation: indications, technique, and complications. Dermatol Surg 33:572–578

    Article  PubMed  CAS  Google Scholar 

  41. Levy RM, Redbord KP, Hanke CW (2008) Treatment of HIV lipoatrophy and lipoatrophy of aging with poly-l-lac-tic acid: a prospective 3-year follow-up study. J Am Acad Dermatol 59:923–933

    Article  PubMed  Google Scholar 

  42. Lowe N, Maxwell A, Patnaik R (2005) Adverse reactions to dermal fillers: review. Dermatol Surg 31:1616–1625

    PubMed  CAS  Google Scholar 

  43. Macfarlane R, Levin AV, Weksberg R, et al (1995) Absence of the greater sphenoid wing in neurofibromatosis type 1: congenital or acquired: case report. Neurosurgery 37:129–133

    Article  PubMed  CAS  Google Scholar 

  44. Malhotra R (2007) Deep orbital sub-Q Restylane (Nonanimal stabilized hyaluronic acid) for orbital volume enhancement in sighted and anophthalmic orbits. Arch Ophth 125:1623–1629

    Article  Google Scholar 

  45. Mancici R, Taban M, Lowinger A, et al (2009) Use of hyaluronic acid gel in the management of paralytic lago-phthalmos: the hyaluronic acid gel “gold weight”. Ophthal Plast Reconstr Surg 25:23–26

    Article  Google Scholar 

  46. Miller JJ, Popp JC (2002) Fat hypertrophy after autologous fat transfer. Ophthal Plast Reconstr Surg 18:228–231

    Article  PubMed  Google Scholar 

  47. Morley AM, Malhotra R (2009) The use of hyaluronic acid filler (Perlane®) for tear trough rejuvenation as an alternative to lower eyelid surgery. Ophthal Plast Reconstr Surg (in press)

    Google Scholar 

  48. Morley AM, Taban M, Malhotra R, Goldberg RA (2009) Use of hyaluronic acid gel for upper eyelid filling and contouring. Ophthal Plast Reconstr Surg (in press)

    Google Scholar 

  49. Pessa JE, Zadoo V, Mutimer K, et al (1998) Relative maxillary retrusion as a natural consequence of aging: combining skeletal and soft-tissue changes into an integrated model of midfacial aging. Plast Reconstr Surg 102:205–212

    Article  PubMed  CAS  Google Scholar 

  50. Pessa JE, Desvigne LD, Lambros VS, et al (1999) Changes in ocular globe-to-orbital rim position with age: implications for aesthetic blepharoplasty of the lower eyelids. Aesth Plast Surg 23:337–342

    Article  CAS  Google Scholar 

  51. Piacquadio D (1994) Crosslinked hyaluronic acid gel (hylan gel) as a softtissue augmentation material: A preliminary assessment. In: Elson ML (ed) Evaluation and treatment of the aging face. Springer-Verlag, New York, pp 304–308

    Google Scholar 

  52. Ross J, Malhotra R (2009) Orbitofacial rejuvenation of temple hollowing with Restylane Perlane injectable filler. Presentation at the British Oculoplastic Surgery Society Annual Meeting.

    Google Scholar 

  53. Schanz S, Schippert W, Ulmer A, et al (2002) Arterial embolization caused by injection of hyaluronic acid (Restylane). Br J Dermatol 146:928–929

    Article  PubMed  CAS  Google Scholar 

  54. SeiffSR (2002) The fat pearl graft in ophthalmic plastic surgery: everyone wants to be a donor! Orbit Jun;21:105–109

    Article  PubMed  Google Scholar 

  55. Shin H, Lemke BN, Stevens TS, Lim MJ (1988) Posterior ciliary artery occlusion after subcutaneous silicone-oil injection. Ann Ophthalmol 20:342–344

    PubMed  CAS  Google Scholar 

  56. Shorr N, Christenbury JD, Goldberg RA (1988) Free autogenous “pearl fat” grafts to the eyelids. Ophthal Plast Reconstr Surg 4:37–40

    Article  PubMed  CAS  Google Scholar 

  57. Simamora P, Chern W (2006) Ploy-L-lactic acid: an overview. J Drugs Dermatol 5:436–440

    PubMed  Google Scholar 

  58. Stegman SJ, Chu S, Armstrong RC (1988) Adverse reactions to bovine collagen implant: clinical and histological features. J Dermatol Surg Oncol 14:39–48

    Article  Google Scholar 

  59. Steinsapir KD, Steinsapir SM (2006) Deep-fill hyaluronic acid for the temporary treatment of the naso-jugal groove: a report of 303 consecutive treatments. Ophthal Plast Reconstr Surg 22:344–348

    Article  PubMed  Google Scholar 

  60. Talar-Williams C, Sneller MC, Langford CA, et al (2005) Orbital socket contracture: a complication of inflammatory orbital disease in patients with Wegener's granulomatosis. Br J Ophthalmol 89:493–497

    Article  PubMed  CAS  Google Scholar 

  61. Teimourian B (1988) Blindness following fat injections. Plast Reconstr Surg 82:361

    PubMed  CAS  Google Scholar 

  62. Tzikas TL (2008) A 52-month summary of results using calcium hydroxlapatite for facial softtissue augmentation. Dermatol Surg 34(Suppl):S9–15

    Article  PubMed  CAS  Google Scholar 

  63. VagefiMR, McMullan TF, Burroughs JR, et al (2007) Injectable calcium hydroxlapatite for orbital volume augmentation. Arch Facial Plast Surg 9:439–442

    Article  PubMed  Google Scholar 

  64. Zimbler MS, Kokoska MS, T omas JR (2001) Anatomy and pathophysiology of facial aging. Facial Plast Surg Clin North Am 9:179–187

    PubMed  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Queen Victoria Hospital, Corneoplastic Unit, East Grinstead, West Sussex, UK

    Ana M. Susana Morley

  2. Department of Ophthalmology, St. Th omas' Hospital, Westminster Bridge Rd., London, SE1 7EH, UK

    Ana M. Susana Morley

  3. Queen Victoria Hospital, Corneoplastic Unit, Holtye Road, East Grinstead, West Sussex, RH19 3DZ, UK

    Raman Malhotra

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  1. Ana M. Susana Morley
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  2. Raman Malhotra
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Editors and Affiliations

  1. Department of Ophthalmology, University of Rostock, Doberaner Straße 140, 18055, Rostock, Germany

    Rudolf F. Guthoff (Professor of Ophthalmology) (Professor of Ophthalmology)

  2. Children's Hospital of Philadelphia, R. D. Wood Ambulatory Care Building Division of Ophthalmology, 34th Street Civic Center Blvd., Philadelphia, PA, 19104, USA

    James A. Katowitz (Professor of Ophthalmology) (Professor of Ophthalmology)

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Morley, A.M.S., Malhotra, R. (2010). Non-surgical Volume Enhancement with Fillers in the Orbit and Periorbital Tissues: Cosmetic and Functional Considerations. In: Guthoff, R.F., Katowitz, J.A. (eds) Oculoplastics and Orbit. Essentials in Ophthalmology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-85542-2_15

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  • DOI: https://doi.org/10.1007/978-3-540-85542-2_15

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